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Lin KW, Chen YJ, Hou SW, Tang SC, Chiang WC, Tsai LK, Lee CW, Lee YC, Chien YC, Hsieh MJ, Jeng JS, Huei-Ming Ma M. Effect of using G-FAST to recognize emergent large vessel occlusion: A city-wide community experience. J Formos Med Assoc 2023; 122:1069-1076. [PMID: 37120338 DOI: 10.1016/j.jfma.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND/PURPOSE A prehospital bypass strategy was suggested for large vessel occlusion. This study aimed to evaluate the effect of a bypass strategy using the gaze-face-arm-speech-time test (G-FAST) implemented in a metropolitan community. METHODS Pre-notified patients with positive Cincinnati Prehospital Stroke Scale and symptom onset <3 h from July 2016 to December 2017 (pre-intervention period) and those with positive G-FAST and symptom onset <6 h from July 2019 to December 2020 (intervention period) were included. Patients aged <20 years and those with missing in-hospital data were excluded. The primary outcomes were the rates of receiving endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT). The secondary outcomes were total prehospital time, door-to-computed tomography (CT) time, door-to-needle (DTN) time, and door-to-puncture (DTP) time. RESULTS We included 802 and 695 pre-notified patients from the pre-intervention and intervention periods, respectively. The characteristics of the patients in the two periods were similar. In the primary outcomes, pre-notified patients during the intervention period showed higher rates of receiving EVT (4.49% vs. 15.25%, p < 0.001) and IVT (15.34% vs. 21.58%, p = 0.002). In the secondary outcomes, pre-notified patients during intervention period had longer total prehospital time (mean 23.38 vs 25.23 min, p < 0.001), longer door-to-CT time (median 10 vs 11 min, p < 0.001), longer DTN time (median 53 vs 54.5 min, p < 0.001) but shorter DTP time (median 141 vs 139.5 min, p < 0.001). CONCLUSION The prehospital bypass strategy with G-FAST showed benefits for stroke patients.
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Affiliation(s)
- Kai-Wei Lin
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ying-Ju Chen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Wen Hou
- Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ching Lee
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Chun Chien
- Emergency Medical Services Division, National Fire Agency, Ministry of the Interior, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
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Ho GR, Wei CW, Kuo HC. Voiding Dysfunction Due to Urethral Sphincter Dysfunction Might Be an Early Neurological Presentation of Central Nervous System Disorders in Aged Patients. J Pers Med 2023; 13:jpm13040693. [PMID: 37109078 PMCID: PMC10142522 DOI: 10.3390/jpm13040693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/06/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
PURPOSE To investigate the incidence of central nervous system (CNS) diseases in adult patients with voiding dysfunction and videourodynamics (VUDS) proven urethral sphincter dysfunction. METHODS This retrospective analysis reviewed the medical charts of patients aged > 60 years who underwent VUDS for non-prostatic voiding dysfunction from 2006 to 2021. A chart review was performed to search for the occurrence and treatment of CNS diseases after the VUDS examination up to 2022. The diagnosis of CNS disease, such as cerebrovascular accidents (CVA), Parkinson's disease (PD), and dementia, by neurologists was also retrieved from the charts. Based on the VUDS findings, patients were divided into the following subgroups: dysfunctional voiding (DV), poor relaxation of the external sphincter (PRES), and hypersensitive bladder (HSB) and coordinated sphincter subgroups. The incidence of CVA, PD, and dementia in each subgroup was recorded and compared among them using one-way analysis of variance (ANOVA). RESULTS A total of 306 patients were included. VUDS examinations revealed DV in 87 patients, PRES in 108, and HSB in 111. Among them, 36 (11.8%) patients had CNS disease, including CVA in 23 (7.5%), PD in 4 (1.3%), and dementia in 9 (2.9%). Among the three subgroups, the DV group had the highest incidence rate of CNS disease (n = 16, 18.4%), followed by PRES (n = 12, 11.1%) and HSB (n = 8, 7.2%). However, no significant difference was noted in the incidence of CNS disease across the three subgroups. Nevertheless, the incidence of CNS disease was higher in patients with DV and PRES than that in the general population. CONCLUSIONS The incidence of CNS diseases was high in patients aged > 60 years with voiding dysfunction due to urethral sphincter dysfunction. Patients with VUDS-confirmed DV had the highest incidence of CNS disease among the three subgroups.
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Affiliation(s)
- Guan-Ru Ho
- Department of Medical Education, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231405, Taiwan
| | - Chiao-Wen Wei
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
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Tsai CF, Wang YH, Teng NC, Yip PK, Chen LK. Incidence, subtypes, sex differences and trends of stroke in Taiwan. PLoS One 2022; 17:e0277296. [PMID: 36383604 PMCID: PMC9668115 DOI: 10.1371/journal.pone.0277296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chinese populations have been reported higher incidence of all strokes and intracerebral hemorrhage. However, few large-scale studies have evaluated changes of stroke epidemiology in the 21st century. METHODS We explored the rates of incidence of all first-ever strokes, subtypes, and 1-month case fatality by using data from the Taiwan National Health Insurance Research Database since 2004. Also, we investigated sex differences in stroke. Time-trend analysis was performed for incidence and case fatality rates of all strokes and subtypes in both sexes. RESULTS The age-adjusted incidence of all strokes per 100,000 person-years decreased by 16%, from 251 (95% confidence interval [CI] 249-253) in 2004 to 210 (95% CI 209-212) in 2011 (p<0.001); it was always higher in Chinese men than in women. Among pathological subtypes, the incidence of intracerebral hemorrhage markedly decreased by 26% over the years (p<0.001), while that of ischemic stroke slightly decreased by 8%. However, when stratified by sex, the incidence of ischemic stroke decreased significantly in only women, not in men (men: p = 0.399, women: p = 0.004). Regarding the incidence of subarachnoid hemorrhage, it remained unchanged. Furthermore, the rate of 1-month case fatality decreased significantly for all strokes in both sexes (p<0.001). CONCLUSIONS In Taiwan, the incidence rate of first-ever stroke decreased in both Chinese men and women in the early 21st century. Men had a higher incidence rate than women. Furthermore, a marked decrease was noted in the incidence of intracerebral hemorrhage, while a slight decrease was noted in that of ischemic stroke; however, the decreased incidence of ischemic stroke was significant in only women.
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Affiliation(s)
- Chung-Fen Tsai
- Division of Neurology, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- * E-mail: (CFT); (LKC)
| | - Ya-Hui Wang
- Medical Research Center, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Nai-Chi Teng
- Institute of Population Health Sciences, National Health Research Institutes, New Taipei City, Taiwan
| | - Ping-Keung Yip
- Division of Neurology, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Kwang Chen
- Institute of Population Health Sciences, National Health Research Institutes, New Taipei City, Taiwan
- * E-mail: (CFT); (LKC)
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Tsung TH, Huang KH, Chien WC, Chen YH, Yen IC, Chung CH, Chen JT, Chen CL. Uveitis increases the risk of stroke among patients with ankylosing spondylitis: A nationwide population-based longitudinal study. Front Immunol 2022; 13:959848. [PMID: 36275682 PMCID: PMC9583155 DOI: 10.3389/fimmu.2022.959848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/30/2022] [Indexed: 11/21/2022] Open
Abstract
Ankylosing spondylitis (AS) is known to increase the risk of stroke. Among patients with AS, uveitis is the most common extra-articular manifestation. However, no previous investigations have discussed the association between uveitis and the risk for developing stroke in patients with AS. This retrospective cohort study aimed to explore the relationship between uveitis and the incidence of stroke in patients with AS by obtaining medical records from January 1, 2000, to December 31, 2015, from the National Health Insurance Research Database, according to the International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. The primary outcome was the incidence of stroke. Pearson’s chi-square test and Fisher’s exact test were used to analyze variables. Kaplan–Meier survival curves and univariate and multivariate Cox proportional hazard regression models with and without Fine and Gray’s competing risk model were used to analyze data. Total 828 AS patients with uveitis and 3,312 AS patients without uveitis were identified. During the follow-up period, 137 patients in the uveitis group and 344 in the non-uveitis group developed stroke. Uveitis is a significant risk factor for stroke development in patients with AS (adjusted hazard ratio = 1.846, p < 0.001). Age, diabetes mellitus, hyperlipidemia, hypertension, congestive heart failure, chronic obstructive pulmonary disease, asthma, coronary artery disease, and atrial fibrillation were associated with a higher risk of stroke. After subgroup analysis, both anterior uveitis and posterior segment involvement were found to increase the risk of stroke in patients with AS. Uveitis is associated with an increased risk in both ischemic and hemorrhagic strokes in patients with AS. Therefore, when uveitis is identified, clinicians should pay more attention to the cerebrovascular risk in patients with AS, especially in those with underlying comorbidities.
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Affiliation(s)
- Ta-hsin Tsung
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ke-Hao Huang
- Department of Ophthalmology, Song-Shan Branch of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - I-Chuan Yen
- School of Pharmacy, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Ching-Long Chen,
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Chen KH, Chai HT, Lin KC, Chiang JY, Sung PH, Chen CH, Yip HK. Dose-dependent benefits of iron-magnetic nanoparticle-coated human umbilical-derived mesenchymal stem cell treatment in rat intracranial hemorrhage model. Stem Cell Res Ther 2022; 13:265. [PMID: 35729660 PMCID: PMC9210819 DOI: 10.1186/s13287-022-02939-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 06/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study tested whether two doses of human umbilical-derived mesenchymal stem cells (hUC-MSCs) were superior to one dose for protecting the brain against intracranial hemorrhage (ICH) induced by intracranial injection collagenase and the capacity of ironic-magnetic-nanoparticles (Ir-MNa) coated hUC-MSCs tracked by MRI. METHODS AND RESULTS Adult male SD rats (n = 40) were equally categorized into group 1 (sham-operated-control), group 2 (ICH), group 3 [ICH + Ir-MNa-coated hUC-MSCs/1.2 × 106 cells with an extracorporeal magnet over rat head (eCMag)/administered by left internal carotid artery (LICA) at post-3 h ICH], and group 4 (ICH + Ir-MNa-coated hUC-MSCs/1.2 × 106 cells with an eCMag/administered post-3 h ICH by LICA and 24 h by IV) and euthanized by day 28. The result showed that by day 28 after ICH induction the neurological function was severely impaired in group 2 than in group 1 that was significantly improved in group 3 and further significantly improved in group 4, whereas ICH volume exhibited an opposite pattern of neurological impairment among the groups (all p < 0.0001). Brain MRI demonstrated that by 4 h after ICH, Ir-MNa-coated hUC-MSCs were abundantly identified in ischemic area in group 4. The protein expressions of inflammatory (TNF-α/MMP-9/IL-1ß/iNOS)/oxidative-stress (NOX-1/NOX-2/oxidized protein)/apoptotic (caspase-3/mitochondrial Bax/PARP)/fibrotic (Smad3/TGF-ß)/mitochondrial-damaged (cytosolic-cytochrome-C) biomarkers displayed an identical pattern of neurological impairment among the groups (all p < 0.0001). The cellular expressions of inflammation (CD68+/CD11b+)/brain edema (AQP4+) biomarkers exhibited an identical pattern, whereas the neuronal-myelin (Doublecortin+/NeuN/nestin) biomarkers displayed an opposite pattern of neurological impairment (all p < 0.0001). CONCLUSION Two doses of hUC-MSCs were superior to just one dose for protecting the brain against ICH-induced damage and Ir-MNa-coated hUC-MSCs offered a well adopted method for tracking hUC-MSCs homing into the brain.
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Affiliation(s)
- Kuan-Hung Chen
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC.,Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Han-Tan Chai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Kun-Chen Lin
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - John Y Chiang
- Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, 80424, Taiwan, ROC
| | - Pei-Hsun Sung
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC.,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC.,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC
| | - Chih-Hung Chen
- Divisions of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC
| | - Hon-Kan Yip
- Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC. .,Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, Taiwan, ROC. .,Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 83301, Taiwan, ROC. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC. .,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, 40402, Taiwan, ROC. .,Department of Nursing, Asia University, Taichung, 41354, Taiwan, ROC. .,Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Xiamen, 361028, Fujian, China.
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6
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Dynamic Changes and Temporal Association with Ambient Temperatures: Nonlinear Analyses of Stroke Events from a National Health Insurance Database. J Clin Med 2021; 10:jcm10215041. [PMID: 34768561 PMCID: PMC8584505 DOI: 10.3390/jcm10215041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The associations between ambient temperatures and stroke are still uncertain, although they have been widely studied. Furthermore, the impact of latitudes or climate zones on these associations is still controversial. The Tropic of Cancer passes through the middle of Taiwan and divides it into subtropical and tropical areas. Therefore, the Taiwan National Health Insurance Database can be used to study the influence of latitudes on the association between ambient temperature and stroke events. Methods: In this study, we retrieved daily stroke events from 2010 to 2015 in the New Taipei and Taipei Cities (the subtropical areas) and Kaohsiung City (the tropical area) from the National Health Insurance Research Database. Overall, 70,338 and 125,163 stroke events, including ischemic stroke and intracerebral hemorrhage, in Kaohsiung City and the Taipei Area were retrieved from the database, respectively. We also collected daily mean temperatures from the Taipei and Kaohsiung weather stations during the same period. The data were decomposed by ensemble empirical mode decomposition (EEMD) into several intrinsic mode functions (IMFs). There were consistent 6-period IMFs with intervals around 360 days in most decomposed data. Spearman’s rank correlation test showed moderate-to-strong correlations between the relevant IMFs of daily temperatures and events of stroke in both areas, which were higher in the northern area compared with those in the southern area. Conclusions: EEMD is a useful tool to demonstrate the regularity of stroke events and their associations with dynamic changes of the ambient temperature. Our results clearly demonstrate the temporal association between the ambient temperature and daily events of ischemic stroke and intracranial hemorrhage. It will contribute to planning a healthcare system for stroke seasonally. Further well-designed prospective studies are needed to elucidate the meaning of these associations.
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Chen KH, Shao PL, Li YC, Chiang JY, Sung PH, Chien HW, Shih FY, Lee MS, Chen WF, Yip HK. Human Umbilical Cord-Derived Mesenchymal Stem Cell Therapy Effectively Protected the Brain Architecture and Neurological Function in Rat After Acute Traumatic Brain Injury. Cell Transplant 2021; 29:963689720929313. [PMID: 33169616 PMCID: PMC7784577 DOI: 10.1177/0963689720929313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Intracranial hemorrhage from stroke and head trauma elicits a cascade of inflammatory and immune reactions detrimental to neurological integrity and function at cellular and molecular levels. This study tested the hypothesis that human umbilical cord–derived mesenchymal stem cell (HUCDMSC) therapy effectively protected the brain integrity and neurological function in rat after acute traumatic brain injury (TBI). Adult male Sprague-Dawley rats (n = 30) were equally divided into group 1 (sham-operated control), group 2 (TBI), and group 3 [TBI + HUCDMSC (1.2 × 106 cells/intravenous injection at 3 h after TBI)] and euthanized by day 28 after TBI procedure. The results of corner test and inclined plane test showed the neurological function was significantly progressively improved from days 3, 7, 14, and 28 in groups 1 and 3 than in group 2, and group 1 than in group 3 (all P < 0.001). By day 28, brain magnetic resonance imaging brain ischemic volume was significantly increased in group 2 than in group 3 (P < 0.001). The protein expressions of apoptosis [mitochondrial-bax positive cells (Bax)/cleaved-caspase3/cleaved-poly(adenosine diphosphate (ADP)-ribose) polymerase], fibrosis (Smad3 positive cells (Smad3)/transforming growth factor-β), oxidative stress (NADPH Oxidase 1 (NOX-1)/NADPH Oxidase 2 (NOX-2)/oxidized-protein/cytochrome b-245 alpha chain (p22phox)), and brain-edema/deoxyribonucleic acid (DNA)–damaged biomarkers (Aquaporin-4/gamma H2A histone family member X ( (γ-H2AX)) displayed an identical pattern to neurological function among the three groups (all P < 0.0001), whereas the protein expressions of angiogenesis biomarkers (vascular endothelial growth factor/stromal cell–derived factor-1α/C-X-C chemokine receptor type 4 (CXCR4)) significantly increased from groups 1 to 3 (all P < 0.0001). The cellular expressions of inflammatory biomarkers (cluster of differentiation 14 (+) cells (CD14+)/glial fibrillary acidic protein positive cells (GFAP+)/ a member of a new family of EGF-TM7 molecules positive cells (F4/80+)) and DNA-damaged parameter (γ-H2AX) exhibited an identical pattern, whereas cellular expressions of neural integrity (hexaribonucleotide Binding Protein-3 positive cells (NeuN+)/nestin+/doublecortin+) exhibited an opposite pattern of neurological function among the three groups (all P < 0.0001). Xenogeneic HUCDMSC therapy was safe and it significantly preserved neurological function and brain architecture in rat after TBI.
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Affiliation(s)
- Kuan-Hung Chen
- Department of Anesthesiology, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Pei-Lin Shao
- Department of Nursing, 63267Asia University, Taichung
| | - Yi-Chen Li
- Division of Cardiology, Department of Internal Medicine, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - John Y Chiang
- Department of Computer Science and Engineering, 34874National Sun Yat-sen University, Kaohsiung.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Hui-Wen Chien
- Department of Nursing, 63267Asia University, Taichung
| | - Fu-Yuan Shih
- Department of Neurosurgery, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Mel S Lee
- Department of Orthopedics, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Wu-Fu Chen
- Department of Neurosurgery, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.,Department of Neurosurgery, Xiamen Chang Gung Hospital, Fujian, China.,Department of Marine Biotechnology and Resources, 34874National Sun Yat-sen University, Kaohsiung
| | - Hon-Kan Yip
- Department of Nursing, 63267Asia University, Taichung.,Division of Cardiology, Department of Internal Medicine, 63328Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.,Institute for Translational Research in Biomedicine, 63328Kaohsiung Chang Gung Memorial Hospital.,Center for Shockwave Medicine and Tissue Engineering, 63328Kaohsiung Chang Gung Memorial Hospital.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung.,Division of Cardiology, Department of Internal Medicine, Xiamen Chang Gung Hospital, Fujian, China
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8
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Inchai P, Tsai WC, Chiu LT, Kung PT. Incidence, risk, and associated risk factors of stroke among people with different disability types and severities: A national population-based cohort study in Taiwan. Disabil Health J 2021; 14:101165. [PMID: 34266788 DOI: 10.1016/j.dhjo.2021.101165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The number of people with disabilities is increasing. People with disabilities are more likely to be physically inactive, which can lead to chronic diseases, including stroke. Stroke is a leading cause of illness and death worldwide, but little is known regarding stroke among people with disabilities. OBJECTIVE To evaluate the incidence density rate, relative risk, and associated risk factors of stroke and measure the risk of death due to stroke among people with disabilities in Taiwan. METHODS This retrospective cohort study used nationwide data from the National Health Insurance Research Database, National Disability Registry Database, and Cause of Death File. Incidence density rates of stroke were estimated as new cases per 1000 person-years. Cox proportional hazard models were used to estimate the relative risk of stroke, adjusted survival curves, and adjusted cumulative incidence curves. RESULTS A total of 670,630 people with disabilities were included in our analyses. The average person-years of observation was 9.43 ± 5.31, with a yearly rate of 16.72 new cases of stroke per 1000 person-years. The highest risk of stroke was found among people with balance disorder (hazard ratio [HR] = 2.27, 95% confidence interval [CI] = 2.00-2.57) and intractable epilepsy (HR = 1.85, 95% CI = 1.56-2.19). The highest risk of death due to stroke was found among people with dementia and multiple disabilities. CONCLUSIONS Stroke rates were higher among people with disabilities than among the general population, and certain disabilities were associated with a higher stroke risk and death rate.
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Affiliation(s)
- Puchong Inchai
- Graduate Institute of Public Health, College of Public Health, China Medical University, Taichung, Taiwan, ROC; Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC.
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Chiu EC, Chi FC, Chen PT. Investigation of the home-reablement program on rehabilitation outcomes for people with stroke: A pilot study. Medicine (Baltimore) 2021; 100:e26515. [PMID: 34190182 PMCID: PMC8257914 DOI: 10.1097/md.0000000000026515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Reablement is 1 approach to conduct rehabilitation in the community (ie, home environment), which aims to enhance an individual's functional ability to perform everyday activities that individuals perceive as important. We investigated the effects of a home-reablement program on different rehabilitation outcomes in people with stroke. METHODS A single-blind randomized clinical trial was conducted. Twenty-six people with stroke were randomly assigned to the home-reablement group or control group. For 6 weeks, participants in the home-reablement group received training for activities of daily living (ADL) that they perceived as important but difficult to perform. Participants in the control group received conventional rehabilitation in the hospital. Outcome measures included the Fugl-Meyer Assessment for the upper-extremity (FMA-UE) and the Stroke Impact Scale 3.0 (SIS 3.0) subscales. RESULTS No statistically significant differences between the 2 groups were noticed in the FMA-UE and the SIS 3.0 subscales (P = .226-1.000). Small effect size (success rate difference = 0.12-0.25) were noticed in the FMA-UE and the 5 SIS 3.0 subscales. The home-reablement group exhibited a greater proportion of participants with scores greater than the minimal detectable change in the FMA-UE and the 6 SIS 3.0 subscales (ie, strength, ADL/instrumental ADL, mobility, emotion, memory, and participation). CONCLUSIONS People with stroke that underwent the 6-week home-reablement program showed potential for improving their motor function, ADL/instrumental ADL, emotion, memory, and activity participation.
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Affiliation(s)
- En-Chi Chiu
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Fang-Chi Chi
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
- Taipei City Long-Term Care Management Center, Taipei, Taiwan
| | - Pei-Tsen Chen
- Department of Physical Medicine and Rehabilitation, Cardinal Tien Hospital, New Taipei City, Taiwan
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10
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Lee KP, Chang AYW, Sung PS. Association between Blood Pressure, Blood Pressure Variability, and Post-Stroke Cognitive Impairment. Biomedicines 2021; 9:773. [PMID: 34356837 PMCID: PMC8301473 DOI: 10.3390/biomedicines9070773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 12/18/2022] Open
Abstract
After stroke, dynamic changes take place from necrotic-apoptotic continuum, inflammatory response to poststroke neurogenesis, and remodeling of the network. These changes and baseline brain pathology such as small vessel disease (SVD) and amyloid burden may be associated with the occurrence of early or late poststroke cognitive impairment (PSCI) or dementia (PSD), which affect not only stroke victims but also their families and even society. We reviewed the current concepts and understanding of the pathophysiology for PSCI/PSD and identified useful tools for the diagnosis and the prediction of PSCI in serological, CSF, and image characteristics. Then, we untangled their relationships with blood pressure (BP) and blood pressure variability (BPV), important but often overlooked risk factors for PSCI/PSD. Finally, we provided evidence for the modifying effects of BP and BPV on PSCI as well as pharmacological and non-pharmacological interventions and life style modification for PSCI/PSD prevention and treatment.
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Affiliation(s)
- Kang-Po Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Neurology, E-DA Hospital, Kaohsiung 824, Taiwan
| | - Alice Y. W. Chang
- Department of Physiology, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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11
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Lin SF, Hu HH, Ho BL, Chen CH, Chan L, Lin HJ, Sun Y, Lin YY, Chen PL, Lin SK, Wei CY, Lin YT, Lee JT, Chao AC. Pre-treatment of Single and Double Antiplatelet and Anticoagulant With Intravenous Thrombolysis for Older Adults With Acute Ischemic Stroke: The TTT-AIS Experience. Front Neurol 2021; 12:628077. [PMID: 33692743 PMCID: PMC7937707 DOI: 10.3389/fneur.2021.628077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/02/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to investigate the safety and efficacy of single antiplatelet, anticoagulant and Dual Antiplatelet pre-treatment (DAPP) in older, moderate to high severity acute ischemic stroke patients treated with intravenous thrombolysis (IVT). Methods: A prospective cohort study was conducted to monitor the development of symptomatic intracranial hemorrhage (SICH) and functional outcomes at 90 days. Two different dosages of alteplase were used for IVT. Logistic regression models were used for analysis of the safety and efficacy outcomes. Results: A total of 1,156 patients were enrolled and categorized into six groups based on their pre-treatment medications: (1) aspirin (n = 213), (2) clopidogrel (n = 37), (3) DAPP of aspirin + clopidogrel (n= 27), (4) warfarin (n = 44), (5) any of the above pre-medications (n = 331), and (6) none of these medications as controls (n = 825). The DAPP group showed significantly increased SICH by the NINDS (adjusted OR: 4.90, 95% CI 1.28-18.69) and the ECASS II (adjusted OR: 5.09, 95% CI: 1.01-25.68) standards. The aspirin group was found to significantly improve the favorable functional outcome of the modified Rankin Scale (mRS) of 0-1 (adjusted OR: 1.91, 95% CI, 1.31.2.78), but no significance for mRS of 0-2 (adjusted OR: 1.39, 95% CI, 0.97-1.99). The DAPP group also significantly increased mortality (adjusted OR: 4.75, 95% CI: 1.77-12.72). A significant interaction between different dosages for IVT and the functional status was noted. Compared to standard dose, the DAPP group showed higher proportions of disability and mortality with low dose of IVT. Conclusion: For older adults with higher baseline severity of acute ischemic stroke, DAPP may increase the risk of SICH and mortality post IVT. However, DAPP is still not an indication to withdraw IVT and to prescribe low-dose IVT for older adults.
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Affiliation(s)
- Sheng-Feng Lin
- School of Public Health, College of Public Health, Taipei, Taiwan.,Division of Hospitalist, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan.,Department of Neurology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Han-Hwa Hu
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
| | - Bo-Lin Ho
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Neurology, National Cheng Kung University, Tainan, Taiwan
| | - Lung Chan
- Department of Neurology, Taipei Medical University-Shaung Ho Hospital, Taipei, Taiwan
| | - Huey-Juan Lin
- Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yung-Yang Lin
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Lin Chen
- Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shinn-Kuang Lin
- Stroke Center and Department of Neurology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Cheng-Yu Wei
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yu-Te Lin
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Jiunn-Tay Lee
- Department of Neurology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - A-Ching Chao
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Department of Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Chiu YC, Hsieh MJ, Lin YH, Tang SC, Sun JT, Chiang WC, Tsai LK, Lee CW, Lee YC, Jeng JS. External validation of prehospital stroke scales for emergent large vessel occlusion. Am J Emerg Med 2021; 41:35-39. [PMID: 33383269 DOI: 10.1016/j.ajem.2020.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND It is suggested that a prehospital scale should be utilized to identify patients with emergent large vessel occlusion (ELVO). We aimed to perform external validation of nine ELVO scales. METHODS This single center retrospective observational study included patients with ischemic stroke visiting the emergency department (ED) within 6 h of symptom onset. Participants were excluded if individual items of the National Institute of Health Stroke Scale scores were not recorded or they did not receive brain computed tomography angiography or magnetic resonance imaging before intravenous thrombolysis or endovascular thrombectomy, and within 24 h of ED admission. The first definition of ELVO was emergent occlusion of the internal carotid artery (ICA) and middle cerebral artery segment 1 (M1). The second definition was emergent occlusion of ICA, M1, basilar artery, middle cerebral artery segment 2, anterior cerebral artery segment 1, and posterior cerebral artery segment 1. Area under the receiver operating characteristic curve (AUROC) was constructed to examine discrimination. The sensitivity, specificity, positive predictive value, and negative predictive value of the nine scales under the two ELVO definitions were calculated. RESULTS A total of 1231 patients were included in the study. No significant differences were observed in the AUROC under the two ELVO definitions. However, sensitivity values of these scales were largely different, ranging from 44.56% to 93.68% under the first ELVO definition. The sensitivity values among scales were also different under the second ELVO definition. CONCLUSION Stakeholders in the community should choose suitable scales according to their own system conditions.
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Affiliation(s)
- Yu-Chen Chiu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ching Lee
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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13
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Wang YJ, Yeh TL, Shih MC, Tu YK, Chien KL. Dietary Sodium Intake and Risk of Cardiovascular Disease: A Systematic Review and Dose-Response Meta-Analysis. Nutrients 2020; 12:nu12102934. [PMID: 32992705 PMCID: PMC7601012 DOI: 10.3390/nu12102934] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 12/16/2022] Open
Abstract
Dietary sodium intake has received considerable attention as a potential risk factor of cardiovascular disease. However, evidence on the dose-response association between dietary sodium intake and cardiovascular disease risk is unclear. Embase and PubMed were searched from their inception to 17 August 2020 and studies that examined the association between sodium intake and cardiovascular disease in adolescents were not included in this review. We conducted a meta-analysis to estimate the effect of high sodium intake using a random effects model. The Newcastle-Ottawa Scale assessment was performed. A random-effects dose-response model was used to estimate the linear and nonlinear dose-response relationships. Subgroup analyses and meta-regression were conducted to explain the observed heterogeneity. We identified 36 reports, which included a total of 616,905 participants, and 20 of these reports were also used for a dose-response meta-analysis. Compared with individuals with low sodium intake, individuals with high sodium intake had a higher adjusted risk of cardiovascular disease (Rate ratio: 1.19, 95% confidence intervals = 1.08–1.30). Our findings suggest that there is a significant linear relationship between dietary sodium intake and cardiovascular disease risk. The risk of cardiovascular disease increased up to 6% for every 1 g increase in dietary sodium intake. A low-sodium diet should be encouraged and education regarding reduced sodium intake should be provided.
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Affiliation(s)
- Yi-Jie Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
| | - Tzu-Lin Yeh
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
- Department of Family Medicine, Hsinchu MacKay Memorial Hospital, No. 690, Section 2, Guangfu Road, East District, Hsinchu City 30071, Taiwan
| | - Ming-Chieh Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Rd.,Taipei City 10055, Taiwan; (Y.-J.W.); (T.-L.Y.); (M.-C.S.); (Y.-K.T.)
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 10002, Taiwan
- Correspondence: ; Tel.: +886-2-3366-8017
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14
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Chen WS, Hsu HC, Chuang YW, Lee M, Lu KY, Chen YF, Chen CM. Predictors for the use of traditional Chinese medicine among inpatients with first-time stroke: a population-based study. BMC Complement Med Ther 2020; 20:244. [PMID: 32762664 PMCID: PMC7409405 DOI: 10.1186/s12906-020-03037-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 07/26/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Stroke is one of the major causes of death and disability. The treatments that are provided to patients during hospitalization after an acute stroke are very important in stabilizing their medical condition and enabling the recovery of their motor functions. However, limited information is available regarding the use of traditional Chinese medicine (TCM) during hospitalization for first-time stroke patients. The researchers aimed to investigate the factors affecting TCM use and to provide clinicians with comprehensive information on TCM use among first-time stroke inpatients in Taiwan. METHODS The researchers collected and analyzed data, including patient characteristics, TCM use, and TCM prescription patterns, from the National Health Insurance Research Database in Taiwan for first-time stroke inpatients between 2006 and 2012. RESULTS Among the 89,162 first-time stroke patients, 7455 were TCM users, and 81,707 were TCM nonusers. The predictors for TCM use were as follows: age, 45-64 or < 45 years; men; living in a level 2, 4, or 7 urbanized area; insured amount ≥ 576 USD per month; ischemic stroke; hospitalized for first-time stroke for 8-14 days, 15-28 days, or ≥ 29 days; stroke severity index score 0-9 or 10-19; Charlson-Deyo comorbidity index score 0 or 1-2; hospitalization in a regional or community hospital; receiving rehabilitation; and previous experience with outpatient TCM use. An increase in the number of TCM users was observed from 2006 to 2012. Furthermore, 68.8-79.7% of TCM users used acupuncture only, while 17.8-26.1% used both acupuncture and Chinese herbal medicine. CONCLUSIONS An increasing number of first-time stroke patients have been choosing TCM as a complementary treatment during hospitalization. Moreover, TCM use is associated with demographic, clinical, and socioeconomic characteristics. These findings may help clinicians comprehensively understand the trend and the important factors affecting TCM utilization among patients who are hospitalized due to first-time stroke.
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Affiliation(s)
- Wei-Sen Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Department of Physical Medicine and Rehabilitation, Jing Mei Hospital, Taipei, Taiwan
| | - Hung-Chih Hsu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.,Department of Natural Biotechnology, Nanhua University, Dalin, Chiayi, Taiwan.,Center for Musculoskeletal Regenerative Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Physical Medicine and Rehabilitation, Xiamen Chang Gung Hospital, Xiamen, China
| | - Yi-Wen Chuang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan.,Jinan Rehabilitation Clinic, Tainan, Taiwan
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuan-Yu Lu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan
| | - Yi-Fei Chen
- School of Traditional Chinese Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, No.6, W. Sec., Jiapu Rd.,, Puzih City, Chiayi County, 613, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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15
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Chiu YC, Tang SC, Sun JT, Tsai LK, Hsieh MJ, Lee CW, Jeng JS, Lee YC, Chien YC, Wang YC, Chiang WC, Ma MHM. Using G-FAST to recognize emergent large vessel occlusion: a training program for a prehospital bypass strategy. J Neurointerv Surg 2019; 12:104-108. [PMID: 31337733 DOI: 10.1136/neurintsurg-2019-015171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The shorter the time between the onset of symptoms and reperfusion using endovascular thrombectomy, the better the functional outcome of patients. A training program was designed for emergency medical technicians (EMTs) to learn the gaze-face-arm-speech-time test (G-FAST) score for initiating a prehospital bypass strategy in an urban city. This study aimed to evaluate the effect of the training program on EMTs. METHODS All EMTs in the city were invited to join the training program. The program consisted of a 30 min lecture and a 20 min video which demonstrated the G-FAST evaluation. The participants underwent tests before and after the program. The tests included (1) a questionnaire of knowledge, attitudes, confidence, and behaviors towards stroke care; and (2) watching 10 different scenarios in a video and answering questions, including eight sub-questions of G-FAST parameters, and choosing a suitable receiving hospital. RESULTS In total, 1058 EMTs completed the training program. After the program, significant improvement was noted in knowledge, attitudes, and confidence, as well as scenario judgement. The performance of the EMTs in evaluating G-FAST criteria in comatose patients was relatively poor in the pre-test and improved significantly after the training course. Although the participants answered the G-FAST items correctly, they tended to overtriage the patients and refer them to higher-level hospitals. CONCLUSIONS A short training program can improve the ability to identify stroke patients and choose a suitable receiving hospital. A future training program could put further emphasis on how to evaluate comatose patients and choose a suitable receiving hospital.
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Affiliation(s)
- Yu-Chen Chiu
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Wei Lee
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Ching Lee
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Chun Chien
- Fire Department of the City of Taipei, Taipei, Taiwan
| | | | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital YunlinBranch, Yunlin County, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital YunlinBranch, Yunlin County, Taiwan
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16
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Chen PH, Tsai SY, Pan CH, Chang CK, Su SS, Chen CC, Kuo CJ. Mood stabilisers and risk of stroke in bipolar disorder. Br J Psychiatry 2019; 215:409-414. [PMID: 30295208 DOI: 10.1192/bjp.2018.203] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Research on the risk of stroke following the use of mood stabilisers specific to patients with bipolar disorder is limited.AimsIn this study, we investigated the risk of stroke following the exposure to mood stabilisers in patients with bipolar disorder. METHOD Data for this nationwide population-based study were derived from the Taiwan National Health Insurance Research Database. Among a retrospective cohort of patients with bipolar disorder (n = 19 433), 609 new-onset cases of stroke were identified from 1999 to 2012. A case-crossover study design utilising 14-day windows was applied to assess the acute exposure effect of individual mood stabilisers on the risk of ischaemic, haemorrhagic and other types of stroke in patients with bipolar disorder. RESULTS Mood stabilisers as a group were significantly associated with the increased risk of stroke in patients with bipolar disorder (adjusted risk ratio, 1.26; P = 0.041). Among individual mood stabilisers, acute exposure to carbamazepine had the highest risk of stroke (adjusted risk ratio, 1.68; P = 0.018), particularly the ischaemic type (adjusted risk ratio, 1.81; P = 0.037). In addition, acute exposure to valproic acid elevated the risk of haemorrhagic stroke (adjusted risk ratio, 1.76; P = 0.022). In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk of any type of stroke. CONCLUSIONS Use of carbamazepine and valproic acid, but not lithium and lamotrigine, is associated with increased risk of stroke in patients with bipolar disorder.Declaration of interestNone.
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Affiliation(s)
- Pao-Huan Chen
- Lecturer,Department of Psychiatry,School of Medicine,College of Medicine,Taipei Medical University and Attending Psychiatrist,Department of Psychiatry and Psychiatric Research Center,Taipei Medical University Hospital,Taiwan
| | - Shang-Ying Tsai
- Professor,Department of Psychiatry,School of Medicine,College of Medicine,Taipei Medical University and Attending Psychiatrist,Department of Psychiatry and Psychiatric Research Center,Taipei Medical University Hospital,Taiwan
| | - Chun-Hung Pan
- Attending Psychiatrist,Taipei City Psychiatric Center,Taipei City Hospital and Lecturer,Department of Psychology,National Chengchi University,Taiwan
| | - Chi-Kang Chang
- Attending Psychiatrist,Taipei City Psychiatric Center,Taipei City Hospital,Taiwan
| | - Sheng-Shiang Su
- Research Assistant,Taipei City Psychiatric Center,Taipei City Hospital,Taiwan
| | - Chiao-Chicy Chen
- Professor,Department of Psychiatry, School of Medicine,College of Medicine,Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital and Professor,Department of Psychiatry,Mackay Memorial Hospital and Department of Psychiatry,Mackay Medical College,Taiwan
| | - Chian-Jue Kuo
- Attending Psychiatrist,Taipei City Psychiatric Center,Taipei City Hospital and Associate Professor,Department of Psychiatry,School of Medicine,College of Medicine,Taipei Medical University,Taiwan
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17
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Wu CY, Yu HS, Chai CY, Wen YH, Wu SS, Chang YP, Lin CHR, Tsai JH. Increased ischemic stroke risk in patients with Behçet's disease: A nationwide population-based cohort study. PLoS One 2019; 14:e0218652. [PMID: 31237911 PMCID: PMC6592528 DOI: 10.1371/journal.pone.0218652] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
Background Behçet’s disease (BD) is a recurrent, multisystemic, inflammatory disorder that mainly affects blood vessels. Because recurrent inflammation of blood vessels in the brain plays a crucial role in the development of ischemic stroke, we hypothesized that patients with BD might have an elevated risk of ischemic stroke. This potential association has been suggested in a few case reports, but not epidemiological studies. Hence, the present study aimed to examine the relation between BD and subsequent ischemic stroke in Taiwan using a nationwide, population-based database. Methods To establish a study cohort, the longitudinal data of 306 patients newly diagnosed with BD during 2000–2010 were extracted from the National Health Insurance Research Database, Taiwan. For comparison of ischemic stroke incidence, a control cohort of 1224 subjects without BD was established using a frequency-matched ratio of 1:4 for age, sex, and pre-existing comorbidities. Results During the 10-year follow-up, 13 (4.2%) patients with BD and 20 (1.6%) control subjects experienced ischemic stroke. Kaplan–Meier analysis revealed the higher prevalence of ischemic stroke in the BD group (log-rank test, p = 0.001). After adjusting for comorbidities and demographic characteristics, Cox regression analysis revealed that patients with BD had a 2.77-fold risk of ischemic stroke (95% confidence interval, 1.38–5.57) compared to control subjects. Conclusions Patients with BD have an elevated risk of ischemic stroke. Hence, BD may affect the vascular system in the brain, resulting in a stroke event.
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Affiliation(s)
- Ching-Ying Wu
- Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Cosmetic Science, College of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan
| | - Hsin-Su Yu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
| | - Chee-Yin Chai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsia Wen
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shihn-Sheng Wu
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
| | - Jui-Hsiu Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
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Krel M, Miulli DE, Jung H, Wiginton JG, Brazdzionis J, Wacker MR, Hoshek S, Menoni R. Minimization of Intraparenchymal Hemorrhagic Stroke Size by Optimization of Serum Lipids. Cureus 2019; 11:e4406. [PMID: 31245196 PMCID: PMC6559677 DOI: 10.7759/cureus.4406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Intraparenchymal hemorrhages (IPHs) are the most common type of hemorrhagic stroke. One of the main associated risk factors is total cholesterol (TC) above 200. A severely decreased level of TC potentially interferes with the stabilization of the cell membrane and can potentially lead to a larger hemorrhage. Previous population-based studies have confirmed an association between low TCs and a high incidence of hemorrhagic stroke. It has been established that a TC below 200 decreases the potential for cardiovascular disease. This study suggests that the balance that needs to be achieved between these two extremes presents a unique possibility for an optimal therapeutic range of total cholesterol levels. Materials & methods Inclusion criteria included all adult patients with International Classification of Diseases (ICD)-9/10 code for hemorrhagic stroke, from June 2007 to June 2017. A total of 300 patients met the criteria (N=300). For each patient, the following data were collected: NIH Stroke Scale, TC level, triglyceride level, low-density lipoprotein (LDL) and high-density lipoprotein (HDL), cholesterol reducing medications, size of hemorrhage on computed tomography (CT) of the head, location of hemorrhage, and patient disposition. Statistical analysis was done using the Generalized Linear Modeling with Wald Chi-square as the statistical determinant. Results Intracerebral hemorrhage size is dependent on the intracranial location with brain lobes having larger bleeds. Minimum hemorrhage size was noted in TC 188-196 and this effect was statistically significant independent of location. HDL has a significant independent effect on hemorrhage size with overall minimum bleed occurring in the range of 43-51 mg/dL HDL (98-106 mg/dL for men and 43-51 mg/dL for women). This sex effect within HDL on hemorrhage size is statistically significant. There was a differential effect of HDL dependent on patient race. Asian and black patients had least IPH volume with HDL 70-79 mg/dL, while Hispanic patients had a minimum at 43-51 mg/dL. White patients required a higher HDL, 80-88 mg/dL to minimize the IPH size. The triglyceride level had a statistically significant independent effect on the bleed size with the minimum hemorrhage size occurring in the range of 205-224 mg/dL. This effect was nuanced by patient race with statistically significant minimum IPH size occurring at 144-164 mg/dL for white patients, 124-143 mg/dL for Hispanic and black patients, and 84-103 mg/dL for Asian patients. Post-hospital patient disposition was not significantly affected by any of the above predictor variables. Conclusion This study found TC, HDL and triglycerides in specific ranges are associated with significantly decreased hemorrhage size across all genders and hemorrhage locations. The ranges with the strongest hemorrhage-limiting effect are as follows: TC 188-196 mg/dL, HDL 43-51 mg/dL (98-106 mg/dL for men and 43-51 mg/dL for women), triglycerides 205-224 mg/dL. Lipids both below and above these ranges yield larger bleeds. It also found larger brain areas will have more extensive hemorrhage than smaller brain areas. Future work in this arena should include collaboration with cardiology to determine ideal ranges for both cardio- and neuroprotection as well as a prospective study to validate the applicability of these findings in patient care.
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Affiliation(s)
- Mark Krel
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Henry Jung
- Neurosurgery, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA
| | - James G Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | | | - Silvio Hoshek
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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Lin TA, Gau JP, Liu YC, Ko PS, Wang HY, Chien SH, Liu CJ, Hsiao LT, Chiou TJ, Liu JH. Cerebrovascular disease after allogeneic hematopoietic stem cell transplantation: incidence, risk, and clinical outcome. Int J Hematol 2019; 109:584-592. [PMID: 30864116 DOI: 10.1007/s12185-019-02624-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/30/2022]
Abstract
Cerebrovascular complications after hematopoietic stem cell transplantation (HSCT) cause serious morbidity and often contribute to mortality. The incidence, risk factors, and outcome of cerebrovascular disease (CVD) after allogeneic HSCT remain poorly defined. We retrospectively evaluated 459 adult patients who underwent allogeneic HSCT at a tertiary medical center between January 2003 and December 2015. A total of 20 patients (4.4%) developed post-transplant CVD. All cerebrovascular accidents occurred in the first two years post-transplant. The two-year incidences of post-transplant CVD, intracranial hemorrhage, and cerebrovascular infarction were 6.1%, 3.2%, and 3.2%, respectively. The incidence rate of CVD within two years after HSCT was 34.7 (95% CI 22.3 to - 53.7) per 1000 person-years, which was about tenfold higher than the general Taiwanese population. The only significant risk factor associated with post-transplant CVD is prior exposure to three or more courses of high-dose cytarabine. Post-transplant CVD is associated with dismal outcome and early mortality. The median overall survival of patients with post-transplant CVD was markedly reduced compared with those without CVD (8.0 vs. 60.6 months). Most patients with post-transplant CVD died within two months after the CVD events. Our study demonstrates that CVD remains a devastating complication after allogeneic HSCT in the modern era.
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Affiliation(s)
- Ting-An Lin
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Jyh-Pyng Gau
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yao-Chung Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan. .,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Po-Shen Ko
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hao-Yuan Wang
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sheng-Hsuan Chien
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Liang-Tsai Hsiao
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeon-Jye Chiou
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jin-Hwang Liu
- Division of Hematology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec 2, Shih-Pai Road, Taipei, 112, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Hematology and Oncology, Department of Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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20
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Chung CM, Lin MS, Liu CH, Lee TH, Chang ST, Yang TY, Pan KL, Lin YS. Discontinuing or continuing statin following intracerebral hemorrhage from the view of a national cohort study. Atherosclerosis 2018; 278:15-22. [PMID: 30236866 DOI: 10.1016/j.atherosclerosis.2018.08.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 07/19/2018] [Accepted: 08/30/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Statins improve clinical outcomes in patients with ischemic stroke but there is no evidence of the effect of continuing long-term statin therapy in patients with intracerebral hemorrhage (ICH). The aim of this study was to evaluate the impact of continuing statin after ICH. METHODS Data on patients with ICH was retrieved from the National Health Insurance Research Database of Taiwan. The final population was separated into two groups according to those who continued and those who discontinued statin treatment. All-cause mortality and cardiovascular outcomes were analyzed after a 3 year follow-up after propensity score matching (PSM). RESULTS Of the 114,101 patients with ICH, who were initially enrolled, 2468 patients with dyslipidemia and ICH were included. After PSM, the benefit of statin therapy on mortality appeared from 1 year to the end of the 3-year follow-up period after discharge (statin group versus non-statin group: 4.9% vs.12.3% at 1 year (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.26-0.57) and 12.9% vs. 25.3% at the end of the 3 year follow-up period (HR, 0.45; 95% CI, 0.35-0.58). Compared with the patients using lipophilic statins, those using hydrophilic statins had a significantly lower incidence of all-cause mortality (HR = 0.65, 95% CI = 0.43-0.99). There were no differences between those prescribed moderate-intensity statins and those prescribed high-intensity statins in terms of stroke and all-cause mortality (HR = 0.76; 95% CI = 0.40-1.46). CONCLUSIONS There was a lower risk of all-cause mortality following ICH in patients who continued statin treatment compared with those without statin treatment, especially in those treated with hydrophilic statins.
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Affiliation(s)
- Chang-Min Chung
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ming-Shyan Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan
| | - Shih-Tai Chang
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Teng-Yao Yang
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kuo-Li Pan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan County, Taiwan; Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
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Rivera-Caravaca JM, Esteve-Pastor MA, Roldán V, Marín F, Lip GY. Non-vitamin K antagonist oral anticoagulants: impact of non-adherence and discontinuation. Expert Opin Drug Saf 2017; 16:1051-1062. [DOI: 10.1080/14740338.2017.1351542] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- José Miguel Rivera-Caravaca
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - María Asunción Esteve-Pastor
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
| | - Vanessa Roldán
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBER-CV, Murcia, Spain
| | - Gregory Y.H. Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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22
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Chen WY, Chen LY, Liu HC, Wu CS, Yang SY, Pan CH, Tsai SY, Chen CC, Kuo CJ. Antipsychotic medications and stroke in schizophrenia: A case-crossover study. PLoS One 2017; 12:e0179424. [PMID: 28614417 PMCID: PMC5470719 DOI: 10.1371/journal.pone.0179424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 05/29/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The association between antipsychotic use and the risk of stroke in schizophrenic patients is controversial. We sought to study the association in a nationwide cohort with schizophrenia. METHODS Using a retrospective cohort of patients with schizophrenia (N = 31,976) derived from the Taiwan National Health Insurance Research Database, 802 new-onset cases of stroke were identified within 10 years of follow-up (from 2000 through 2010). We designed a case-crossover study using 14-day windows to explore the risk factors of stroke and the association between antipsychotic drugs and the risk of stroke. We analyzed the risks of individual antipsychotics on various subgroups of stroke including ischemic, hemorrhagic, and other strokes, and the risks based on the antipsychotic receptor-binding profile of each drug. RESULTS Use of any second-generation antipsychotic was associated with an increased risk of stroke (adjusted risk ratio = 1.45, P = .009) within 14 days while the use of any first-generation antipsychotic was not. Intriguingly, the use of any second-generation antipsychotic was associated with ischemic stroke but not hemorrhagic stroke. The antipsychotic receptor-binding profile analysis showed that the antihistamine 1 receptor was significantly associated with ischemic stroke (adjusted risk ratio = 1.72, P = .037), and the sensitivity analysis based on the 7-day window of exposure validated the association (adjusted risk ratio = 1.87, P = .015). CONCLUSIONS Use of second-generation antipsychotic drugs appeared to be associated with an increased risk of ischemic stroke in the patients studied, possibly mediated by high affinity for histamine-1 receptor blockade. Further research regarding the underlying biological mechanism and drug safety is suggested.
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Affiliation(s)
- Wen-Yin Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Lian-Yu Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, National Cheng Kung University, Tainan, Taiwan
| | - Hsing-Cheng Liu
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Yu Yang
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hung Pan
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Shang-Ying Tsai
- Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chiao-Chicy Chen
- Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan and Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
| | - Chian-Jue Kuo
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, Taipei Medical University and Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- * E-mail:
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23
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Effects of Transferring to the Rehabilitation Ward on Long-Term Mortality Rate of First-Time Stroke Survivors: A Population-Based Study. Arch Phys Med Rehabil 2017; 98:2399-2407. [PMID: 28433415 DOI: 10.1016/j.apmr.2017.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 03/08/2017] [Accepted: 03/22/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess the long-term health outcomes of acute stroke survivors transferred to the rehabilitation ward. DESIGN Long-term mortality rates of first-time stroke survivors during hospitalization were compared among the following sets of patients: patients transferred to the rehabilitation ward, patients receiving rehabilitation without being transferred to the rehabilitation ward, and patients receiving no rehabilitation. SETTING Retrospective cohort study. PARTICIPANTS Patients (N = 11,419) with stroke from 2005 to 2008 were initially assessed for eligibility. After propensity score matching, 390 first-time stroke survivors were included. INTERVENTIONS None. MAIN OUTCOME MEASURE Cox proportional hazards regression model was used to assess differences in 5-year poststroke mortality rates. RESULTS Based on adjusted hazard ratios (HRs), the patients receiving rehabilitation without being transferred to the rehabilitation ward (adjusted HR, 2.20; 95% confidence interval [CI], 1.36-3.57) and patients receiving no rehabilitation (adjusted HR, 4.00; 95% CI, 2.55-6.27) had significantly higher mortality risk than the patients transferred to the rehabilitation ward. Mortality rate of the stroke survivors was affected by age ≥65 years (compared with age <45y; adjusted HR, 3.62), being a man (adjusted HR, 1.49), having ischemic stroke (adjusted HR, 1.55), stroke severity (Stroke Severity Index [SSI] score≥20, compared with SSI score<10; adjusted HR, 2.68), and comorbidity (Charlson-Deyo Comorbidity Index [CCI] score≥3, compared with CCI score=0; adjusted HR, 4.23). CONCLUSIONS First-time stroke survivors transferred to the rehabilitation ward had a 5-year mortality rate 2.2 times lower than those who received rehabilitation without transfer to the rehabilitation ward and 4 times lower than those who received no rehabilitation.
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Wang CT, Chuang E, Yen DJ, Chuang TY, Muo CH, Kao CH. First-ever stroke following hip replacement surgeries: a large population-based survey. Eur J Clin Invest 2016; 46:931-939. [PMID: 27644771 DOI: 10.1111/eci.12678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/12/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was designed to determine the prevalence, subtypes and risk factors of first-ever stroke following hip replacement (HR) in a large population of Taiwan. METHODS Using the National Health Insurance system of Taiwan, we identified patients undergoing HR from 2000 to 2011 and randomly selected 4 : 1 age- and sex-matched controls for each HR patients. The index date for HR patients was defined the date for HR. All study subjects were followed from the index date until stroke occurred at admission. T-test and chi-square test were used for continuous and categorical variables, respectively. The hazard ratios of risk factors were determined with Cox proportional hazard regression model. RESULTS A total of 3604 HR patients and 14 394 controls were enrolled. In comparison with controls, patients undergoing HR had a significantly higher incidence of comorbidities (i.e. atrial fibrillation, hypertension, diabetes) and consumed more medications (i.e. antihypertension, antidiabetes, nonsteroid anti-inflammatory drugs and anticoagulants) before surgery. The HR patients had a significant higher incidence of first-ever stroke, especially for those aged over 65. (Hazard ratio: 1·33, 95% confidence interval: 1·12-1·58) The significantly higher risk for first-ever stroke occurred within 3 months and ≥ 1 year after HR. The incidence rate of ischaemic stroke is about five times than that of haemorrhagic stroke. CONCLUSION Our study identifies multiple risk factors that cause cerebrovascular complications after HR, which is vital in creating treatment plans to prevent for said problems.
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Affiliation(s)
- Chia-To Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Eric Chuang
- UC Berkeley Mishler Lab Undergraduate Researcher, Intended B.S. Molecular and Cell Biology, University of California, Berkeley, CA, USA
| | - Der-Jen Yen
- National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tien-Yow Chuang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan.,National Yang-Ming University, Taipei, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan. .,Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan. .,Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.
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25
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Tai SY, Lin FC, Lee CY, Chang CJ, Wu MT, Chien CY. Statin use after intracerebral hemorrhage: a 10-year nationwide cohort study. Brain Behav 2016; 6:e00487. [PMID: 27247857 PMCID: PMC4867570 DOI: 10.1002/brb3.487] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/28/2016] [Accepted: 04/08/2016] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Although statin therapy is beneficial to patients with ischemic stroke, statin use, and intracerebral hemorrhage (ICH) remain a concern. ICH survivors commonly have comorbid cardiovascular risk factors that would otherwise warrant cholesterol-lowering medication, thus emphasizing the importance of assessing the characteristics of statin therapy in this population. METHODS We performed a cohort study by using 10 years of data collected from the National Health Insurance Research Database in Taiwan. We enrolled 726 patients admitted for newly diagnosed ICH from January 1, 2001 to December 31, 2010. The patients were categorized into high- (92), moderate- (545), and low-intensity (89) statin groups, and into hydrophilic (295) and lipophilic (431) statin groups. The composite outcomes included all-cause mortality, recurrent ICH, ischemic stroke, transient ischemic attack, and acute coronary events. RESULTS The patients in the low-intensity group did not differ significantly from the patients in the high-intensity group in risk of all-cause mortality (adjusted hazard ratio [aHR] = 0.65, 95% confidence interval [CI] = 0.28-1.55) and recurrent ICH (aHR = 0.66, 95% CI = 0.30-1.44). In contrast, the patients in the hydrophilic group had a significantly lower risk of recurrent ICH than did those in the lipophilic group (aHR = 0.69, 95% CI = 0.48-0.99). We determined no significant differences in other composite endpoints between hydrophilic and lipophilic statin use. CONCLUSION Hydrophilic statin therapy is associated with a reduced risk of recurrent ICH in post-ICH patients. The intensity of statin use had no significant effect on recurrent ICH or other components of the composite outcome. Additional studies are required to clarify the biological mechanisms underlying these observations.
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Affiliation(s)
- Shu-Yu Tai
- Department of Family Medicine School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan; Department of Family Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan; Department of Family Medicine Kaohsiung Municipal Ta-Tung Hospital Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan
| | - Feng-Cheng Lin
- Department of Neurology Kaohsiung Medical University Hospital Kaohsiung Taiwan; Department of Neurology Pingtung Hospital Ministry of Health and Welfare Pingtung Taiwan
| | - Chung-Yin Lee
- Department of Family Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan
| | - Chai-Jan Chang
- Department of Family Medicine School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan; Department of Family Medicine Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan; Department of Family Medicine Kaohsiung Municipal Hsiao-Kang Hospital Kaohsiung Medical University Kaohsiung Taiwan
| | - Ming-Tsang Wu
- Department of Family Medicine School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan; Department of Public Health Kaohsiung Medical University Kaohsiung Taiwan; Center of Environmental and Occupational Medicine Kaohsiung Municipal Hsiao-Kang Hospital Kaohsiung Medical University Kaohsiung Taiwan
| | - Chen-Yu Chien
- Department of Otorhinolaryngology School of Medicine College of Medicine Kaohsiung Medical University Kaohsiung Taiwan; Department of Otorhinolaryngology Kaohsiung Medical University Hospital Kaohsiung Medical University Kaohsiung Taiwan; Department of Otorhinolaryngology Kaohsiung Municipal Hsiao-Kang Hospital Kaohsiung Medical University Kaohsiung Taiwan
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Chang CF, Kuo YL, Pu C, Chou YJ. Neck dissection and stroke in patients with oral cavity cancer: A population-based cohort study. Head Neck 2016; 39:63-70. [DOI: 10.1002/hed.24535] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chia-Fan Chang
- Department of Otolaryngology, Head and Neck Surgery; Taipei Veterans General Hospital; Taipei Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
- Institute of Hospital and Health Care Management, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yen-Ling Kuo
- Department of Otolaryngology; National Yang-Ming University Hospital; Yilan County Taiwan
- Faculty of Medicine, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Christy Pu
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine; National Yang-Ming University; Taipei Taiwan
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27
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Burke TA, Venketasubramanian RN. The Epidemiology of Stroke in the East Asian Region: A Literature-Based Review. Int J Stroke 2016; 1:208-15. [DOI: 10.1111/j.1747-4949.2006.00060.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Stroke is a leading cause of morbidity and mortality in the developed world. Our objective was to review comparable studies of stroke incidence, prevalence, and subtypes in the East Asian region. English language epidemiologic studies of stroke published from 1984 through 2004 were identified for the East Asian region (China, Hong Kong, Taiwan, Japan, North and South Korea and the ASEAN countries). The Sudlow–Warlow criteria were modified to identify comparable studies. Stroke epidemiology is relatively well characterized in China, Taiwan, and Japan; however, little information is available for other countries. Four studies of stroke incidence, from China, Taiwan, and Japan, were identified, which reported a total of 4995 first-ever stroke events. There was an over twofold difference in the age-adjusted incidence of stroke between the Chinese Seven Cities and Okinawa study (483 vs 201 per 100 000). The 1-month case fatality rate ranged from 12·7% to 17·3%. Only one population-based study on stroke prevalence, from Taiwan, was identified: Studies show the relatively high proportion of hemorrhagic stroke (30%). Stroke epidemiology is relatively well characterized in China, Japan, and Taiwan but not in other countries in the region. More recent data are needed to monitor stroke prevention efforts and guide planning of health care resources in the region.
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28
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Peng KP, Chen YT, Fuh JL, Tang CH, Wang SJ. Migraine and incidence of ischemic stroke: A nationwide population-based study. Cephalalgia 2016; 37:327-335. [DOI: 10.1177/0333102416642602] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The association between migraine and the incidence of ischemic stroke varies in different subgroups of patients. We aimed to clarify this association using a population-based database. Method A nationwide cohort study was conducted using data from the Taiwan National Health Insurance Research Database. Two cohorts were extracted: a neurologist-diagnosed migraine cohort, and a non-headache, propensity score-matched comparison cohort. All participants were enrolled in this study between 2005 and 2009, and were followed through the end of 2010, death, or the occurrence of ischemic stroke. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated with a Cox proportional hazards model to compare the between-group risks. Results Both cohorts ( n = 119,017 each) were followed for a mean period of 3.6 ± 1.3 years. A total of 744 migraine patients (429,741 person-years) and 617 matched comparison individuals (436,141 person-years) developed ischemic stroke during the research period. Compared to the comparison cohort, patients with migraine were at an increased risk of ischemic stroke (aHR: 1.24, 95% CI: 1.12–1.38, p < 0.001). Subgroup analysis by age and sex revealed the highest risk in women aged ≤ 45 years (aHR: 3.44, 95% CI: 2.20–5.39, p < 0.001), especially among those with migraine with aura (aHR: 4.58, 95% CI: 2.45 – 8.56, p < 0.001). A trend for increased stroke risk was observed in men aged ≤ 45 years (aHR: 1.54, 95% CI: 0.96–2.48, p = 0.075). Conclusion Migraine is associated with an increased risk of ischemic stroke, especially in younger (age ≤ 45 years) women with migraine with aura. The trend toward ischemic stroke in younger men merits further exploration.
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Affiliation(s)
- Kuan-Po Peng
- Department of Internal Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taiwan
- Institute of Brain Science, National Yang-Ming University, Taiwan
- National Yang-Ming University School of Medicine, Taiwan
| | - Yung-Tai Chen
- National Yang-Ming University School of Medicine, Taiwan
- Department of Nephrology, Institute of Internal Medicine, Taipei City Hospital Heping Fuyou Branch, Taiwan
| | - Jong-Ling Fuh
- National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, Taipei Medical University, Taiwan
| | - Shuu-Jiun Wang
- Institute of Brain Science, National Yang-Ming University, Taiwan
- National Yang-Ming University School of Medicine, Taiwan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan
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Yu CS, Lin CM, Liu CK, Lu HHS. Impact of baseline characteristics on outcomes of carotid artery stenting in acute ischemic stroke patients. Ther Clin Risk Manag 2016; 12:495-504. [PMID: 27099508 PMCID: PMC4820207 DOI: 10.2147/tcrm.s104933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS) was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline mRS scores >2.
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Affiliation(s)
- Cheng-Sheng Yu
- Institute of Statistics and Big Data Research Center, National Chiao Tung University, Taiwan, Republic of China
| | - Chih-Ming Lin
- Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China; Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, Republic of China
| | - Chi-Kuang Liu
- Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China
| | - Henry Horng-Shing Lu
- Institute of Statistics and Big Data Research Center, National Chiao Tung University, Taiwan, Republic of China
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Chen CW, Wu EH, Huang J, Chang WT, Ao KH, Cheng TJ, Yang W. Dynamic evolution of D-dimer level in cerebrospinal fluid predicts poor outcome in patients with spontaneous intracerebral hemorrhage combined with intraventricular hemorrhage. J Clin Neurosci 2016; 29:149-54. [PMID: 27050917 DOI: 10.1016/j.jocn.2015.10.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 10/11/2015] [Indexed: 10/22/2022]
Abstract
The risk of mortality in patients with intracerebral hemorrhage (ICH) significantly increases when complicated by intraventricular hemorrhage (IVH). We hypothesize that serial measurement of cerebrospinal fluid (CSF) D-dimer levels in patients with both ICH and IVH may serve as an early marker of IVH severity. We performed a prospective study of 43 consecutive ICH patients combined with IVH and external ventricular drainage placement admitted in our institution from 2005-2006. IVH severity (Graeb score) and fibrinolytic activity were evaluated continuously for 7days using CT scans and CSF D-dimer levels. The primary outcome was 30day mortality. Overall 30day mortality was 26% (n=11), with eight deaths (72.7%) after 3days (D3). Graeb score and CSF D-dimer on admission (D0) were not significantly different between survivors and non-survivors. The temporal profiles of both parameters were distinctly different, with a downward trend in survivors and an upward trend in non-survivors. A mortality rate of 54% was observed between D0-D3 when both scores increased during this interval. In contrast, the mortality was only 4% when both measures decreased during this interval. Early phase (D0-D3) CSF D-dimer or Graeb score change demonstrated high sensitivity of 88% and specificity of 81% when predicting 30day mortality. Early phase CSF D-dimer change in patients with both ICH and IVH is accurate in predicting mortality and may be utilized as a cost-effective surrogate indicator of IVH severity. Serial monitoring of CSF D-dimer dynamic changes is useful for early identification of patients with hematoma progression and poor outcome.
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Affiliation(s)
- Chih-Wei Chen
- Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Taiwan; Department of Occupational Safety and Health/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Taiwan
| | - En-Hsuan Wu
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
| | - Judy Huang
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, 6128 Zayed Tower, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21218, USA
| | - Wen-Tsan Chang
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Taiwan; Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Taiwan
| | - Kam-Hou Ao
- Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Taiwan
| | - Tain-Junn Cheng
- Department of Occupational Safety and Health/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Taiwan; Department of Neurology and Occupational Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wuyang Yang
- Department of Neurosurgery, School of Medicine, Johns Hopkins University, 6128 Zayed Tower, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, MD 21218, USA.
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Voukalis C, Lip GY, Shantsila E. Emerging Tools for Stroke Prevention in Atrial Fibrillation. EBioMedicine 2016; 4:26-39. [PMID: 26981569 PMCID: PMC4776061 DOI: 10.1016/j.ebiom.2016.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/07/2016] [Accepted: 01/14/2016] [Indexed: 02/02/2023] Open
Abstract
Ischaemic strokes resulting from atrial fibrillation (AF) constitute a devastating condition for patients and their carers with huge burden on health care systems. Prophylactic treatment against systemic embolization and ischaemic strokes is the cornerstone for the management of AF. Effective stroke prevention requires the use of the vitamin K antagonists or non-vitamin K oral anticoagulants (NOACs). This article summarises the latest developments in the field of stroke prevention in AF and aims to assist physicians with the choice of oral anticoagulant for patients with non-valvular AF with different risk factor profile.
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Key Words
- Atrial fibrillation
- CKD, chronic kidney disease
- CrCl, creatinine clearance
- DM, diabetes mellitus
- ESRF, end stage renal failure
- HF, heart failure
- HTN, hypertension
- ICH, intracranial haemorrhage
- INR, international normalised ratio
- LV, left ventricle
- NCB, net clinical benefit
- NICE, National institute for Health and Care Excellence
- NVAF, non-valvular atrial fibrillation
- Net clinical benefit
- Non-vitamin K oral anticoagulants
- Oral anticoagulation
- PCI, percutaneous coronary intervention
- RSM, risk stratification model
- Risk stratification
- SE, systemic embolism
- Stroke prevention
- TE, thromboembolic episode
- TIA, transient ischaemic attack
- TTR, time in therapeutic range
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
| | | | - Eduard Shantsila
- University of Birmingham, Institute of Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK
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Lee M, Wu YL, Ovbiagele B. Trends in Incident and Recurrent Rates of First-Ever Ischemic Stroke in Taiwan between 2000 and 2011. J Stroke 2015; 18:60-5. [PMID: 26687123 PMCID: PMC4747065 DOI: 10.5853/jos.2015.01326] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/23/2015] [Accepted: 10/25/2015] [Indexed: 12/03/2022] Open
Abstract
Background and Purpose The burden of stroke is comparatively greater in Asian countries than in the Western world. While there has been a documented recent decline in the incidence of stroke in several Western nations due to better risk factor management, much less is known about the nature and trajectory of stroke in Asia over the last decade. The objective of this study was to explore risk factors, medication use, incidence, and one-year recurrence of stroke in Taiwan. Methods We conducted a nationwide cohort study by reviewing all hospitalized patients (≥ 18 years) with a primary diagnosis of ischemic stroke between 2001 and 2011 from Taiwan National Health Insurance Research Database. Results A total of 291,381 first-ever ischemic stroke patients were enrolled between 2000 and 2011. The average age was about 70 years and approximately 58.6% of them were men. While prevalence of diabetes mellitus and hyperlipidemia, as well as use of statins, antiplatelet agents, and oral anticoagulant agents for atrial fibrillation significantly increased; incidence (142.3 vs. 129.5 per 100,000 in 2000 and 2011, respectively) and one-year recurrence (9.6% vs. 7.8% in 2000 and 2011, respectively) of stroke declined during this period of time. Conclusions Over the last decade in Taiwan, rates of primary ischemic stroke and one-year recurrent stroke decreased by 9% and 18% respectively.
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Affiliation(s)
- Meng Lee
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi branch, Taiwan
| | - Yi-Ling Wu
- Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi branch, Taiwan
| | - Bruce Ovbiagele
- Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Abstract
Gallbladder polyp (GP) and stroke share several metabolic disorders as risk factors. We assessed the association between GP and subsequent stroke risk. From 2000 to 2011, patients with GP aged >20 years were identified from the Longitudinal Health Insurance Database 2000. Of the 15,975 examined patients, 12,780 and 3195 were categorized into the non-GP and GP cohorts, respectively. The relative risks of stroke were estimated using the Cox proportional hazard model after adjusting for age, sex, and comorbidities. The overall incidence of stroke was higher in the GP cohort than in the non-GP cohort (6.66 vs 5.20/1000 person-yr), with an incidence rate ratio (IRR) of 1.28 (95% confidence interval [CI] = 1.15-1.42). The risk of stroke was 1.32-fold (95% CI = 1.06-1.63) in patients with GP compared with patients without GP after adjusting for age, sex, income level, urbanization level, occupation and comorbidities of gallstone, alcohol-related illness, diabetes, hyperlipidemia, hypertension, obesity, COPD, coronary heart disease, and asthma. Furthermore, the stroke risk was higher among elderly patients (with 1-yr intervals; adjusted HR [aHR] = 1.06, 95% CI = 1.05-1.07), the male sex (aHR = 1.62, 95% CI = 1.35-1.96), lower income level (aHR = 1.37, 95% CI = 1.02-1.85 for level I; aHR = 1.62, 95% CI = 1.25-2.10 for level II), living in second urbanized areas (aHR = 1.28, 95% CI = 1.00-1.63), alcohol-related illness (aHR = 1.56, 95% CI = 1.07-2.28), diabetes (aHR = 1.78, 95% CI = 1.41-2.24), and hypertension (aHR = 2.74, 95% CI = 2.19-3.42). GP is associated with stroke; however, GP may be less influential than other risk factors are, such as male sex, lower income level, alcohol-related illness, diabetes, and hypertension, on stroke development. Additional studies are required to clarify whether GP is a risk factor for or an epiphenomenon of stroke development.
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Affiliation(s)
- Chien-Hua Chen
- From the Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua (C-HC); Hungkuang University, Taichung (C-HC); Meiho University of Technology, Pingtung (C-HC); School of Medicine, China Medical University (C-LL); Management Office for Health Data, China Medical University Hospital (C-LL); Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University (C-HK); Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Lin SW, Weng WC, Huang YH, Su FC, Peng TI, Chien YY, Wu CL, Lee KY, Yu YJ, Zhu JX, Huang WY. Association between renal dysfunction and 3-year mortality in patients with acute first-ever ischemic stroke. Clin Neurol Neurosurg 2015; 137:15-21. [PMID: 26117593 DOI: 10.1016/j.clineuro.2015.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/10/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The influence of renal dysfunction on the clinical presentation and outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of renal dysfunction on the outcomes of patients with acute first-ever ischemic stroke. METHODS Nine-hundred thirty-four patients with acute first-ever ischemic stroke were enrolled and followed for 3 years. Renal function was assessed using the equation of the Modification Diet for Renal Disease for estimated glomerular filtration rate (eGFR). Serum creatinine levels were obtained within 3 days of acute stroke onset. Reduced eGFR was defined as eGFR<60ml/min/1.73m(2). Clinical presentation, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. RESULTS Total 264 patients (28.3%) had a reduced eGFR. The prevalence of older age, hypertension, and atrial fibrillation was significantly higher in patients with a reduced eGFR. Total anterior circulation syndrome occurred more frequently among patients with a reduced eGFR (P=0.010). Multivariate Cox regression revealed that a reduced eGFR is a significant predictor of 3-year mortality (HR=1.67, 95% CI=1.06-2.62, P=0.026). CONCLUSION Reduced eGFR during the acute stroke stage is associated with increased risk of 3-year mortality. Furthermore, risk of acute complications and poor functional outcomes following discharge was significantly higher in patients with a reduced eGFR.
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Affiliation(s)
- Shun-Wen Lin
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Wei-Chieh Weng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Yu-Hua Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Feng-Chieh Su
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Yu-Yi Chien
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Chia-Lun Wu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Kuang-Yung Lee
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Yi-Jing Yu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Jun-Xue Zhu
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan
| | - Wen-Yi Huang
- Department of Neurology, Chang-Gung Memorial Hospital, Keelung Branch, No. 222, Mai-Jin Road, Keelung Zip. 204, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan Zip. 333, Taiwan.
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Chen CM, Ke YL. Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan. Top Stroke Rehabil 2015; 23:59-66. [PMID: 26094779 DOI: 10.1179/1945511915y.0000000006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs. OBJECTIVES The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design. METHODS All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs. RESULTS The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5 ± 3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI) = 138.5-2012.9], dysphagia [coefficient (B), 1025.8; 95% CI = 193.9-1857.8], number of surgeries [coefficient (B), 796.4; 95% CI = 316.0-1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI = 1339.5-3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI = 221.6-2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI = 31.2-98.7] (R(2) = 0.387). CONCLUSIONS Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital , Chiayi, Taiwan
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Park JB, Kario K, Wang JG. Systolic hypertension: an increasing clinical challenge in Asia. Hypertens Res 2015; 38:227-36. [PMID: 25503845 PMCID: PMC4396396 DOI: 10.1038/hr.2014.169] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 10/14/2014] [Accepted: 10/26/2014] [Indexed: 12/21/2022]
Abstract
Systolic hypertension, the predominant form of hypertension in patients aged over 50-60 years, is a growing health issue as the Asian population ages. Elevated systolic blood pressure is mainly caused by arterial stiffening, resulting from age-related vascular changes. Elevated systolic pressure increases the risk of cardiovascular disease, mortality and renal function decline, and this risk may increase at lower systolic pressure levels in Asian than Western subjects. Hence, effective systolic pressure lowering is particularly important in Asians yet blood pressure control remains inadequate despite the availability of numerous antihypertensive medications. Reasons for poor blood pressure control include low awareness of hypertension among health-care professionals and patients, under-treatment, and tolerability problems with antihypertensive drugs. Current antihypertensive treatments also lack effects on the underlying vascular pathology of systolic hypertension, so novel drugs that address the pathophysiology of arterial stiffening are needed for optimal management of systolic hypertension and its cardiovascular complications.
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Affiliation(s)
- Jeong Bae Park
- Department of Medicine/Cardiology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Singer P, Cohen H, Alderman M. Assessing the associations of sodium intake with long-term all-cause and cardiovascular mortality in a hypertensive cohort. Am J Hypertens 2015; 28:335-42. [PMID: 25159082 DOI: 10.1093/ajh/hpu141] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although higher sodium intake is known to increase blood pressure, its association with cardiovascular mortality is less established. We examined the association of baseline sodium intake in a hypertensive cohort with all-cause and cardiovascular mortality over a mean follow-up of 18.6 years. METHODS Three thousand five hundred five subjects were participants in a worksite hypertension program. Sodium intake was estimated by 24-hour urine excretion. Mortality data were obtained from the U.S. National Death Index. Unadjusted and multivariable-adjusted associations between sodium quartiles (quartile I (QI) to quartile IV (QIV)) and mortality were assessed using Cox models. RESULTS Estimated mean ± SD sodium intake was 130±69 mmol overall (55±20 mmol in QI; 220±56 mmol in QIV). Baseline systolic blood pressure did not vary significantly between groups. Last available mean systolic blood pressure was highest in QI and lowest in QIV (137±16 vs. 134±14 mm Hg; P = 0.009). Overall there were 1,013 deaths (399 cardiovascular). Unadjusted models exhibited significant inverse relationships between sodium and mortality outcomes. In adjusted models, sodium intake was not significantly associated with cardiovascular mortality (QI vs. QIV: hazard ratio (HR) = 1.00; 95% confidence interval (CI) = 0.71-1.42; P = 0.99). A borderline significant direct association with all-cause mortality was observed (QI vs. QIV: HR = 0.81; 95% CI = 0.66-1.00; P = 0.05) driven partly by noncardiovascular deaths. CONCLUSIONS Our study found no significant association between sodium intake and cardiovascular outcomes, although a significant association with all-cause mortality was observed. Although these findings suggest that sodium may not have a strong relationship with cardiovascular mortality, the inconsistent results cast doubt on whether a single measurement can reliably predict mortality over a prolonged follow-up period.
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Affiliation(s)
- Pamela Singer
- Department of Pediatrics, Division of Pediatric Nephrology, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York;
| | - Hillel Cohen
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Michael Alderman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Mehndiratta MM, Khan M, Mehndiratta P, Wasay M. Stroke in Asia: geographical variations and temporal trends. J Neurol Neurosurg Psychiatry 2014; 85:1308-12. [PMID: 24769474 DOI: 10.1136/jnnp-2013-306992] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Asian countries are in various stages of epidemiological transition and therefore exhibit a great diversity in disease patterns. Collectively, they comprise almost two-third of the world's total mortality due to stroke. The purpose of this review is to explore existing epidemiological data on stroke, highlight the temporal trends in stroke epidemiology in various regions of Asia and predict future patterns based on these observations. Our search revealed that there is a lack of good epidemiological data from most Asian countries. Whatever data exist are not comparable due to lack of standardised methodology for ascertaining stroke and its subtypes. For this and other reasons, these estimates exhibit country-to-country variation and also within-country variability. We have also reviewed temporal trends in stroke incidence and prevalence in 12 Asian countries and the evolution of stroke subtypes over the past two decades. Important observations include a rise in stroke incidence in most Asian countries, an earlier age at onset compared with the West, a relative increase in the proportion of ischaemic strokes and a decline in haemorrhagic strokes. Among ischaemic stroke subtypes, lacunar strokes, which were once the commonest variety, are now declining. Emerging data suggest that large artery atherosclerosis and in particular that of intracranial vessels is the predominant aetiology in most Asian countries. The review also identified important gender differences in terms of stroke risk factors, prevalence and outcomes. There is need for sound epidemiological data from most countries to understand the disease better and plan policy-level interventions to decrease the burden. We identify a need for standard format or guidelines for conducting stroke epidemiological studies especially in developing Asian countries. This region must be identified as a priority region for stroke-related interventions and preventive strategies by global healthcare authorities and organisations.
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Affiliation(s)
| | - Maria Khan
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Prachi Mehndiratta
- Department of Vascular Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi, Pakistan
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Abstract
Few nutrient intake recommendations become subjects of heated scientific debate, but sodium is 1 of them. In the absence of sufficient clinical trials focused on sodium intake and health outcomes, studies that used the surrogate marker of blood pressure have been used to support extreme sodium reduction. Under tightly controlled conditions, maximum achievable sodium reduction leads to a 1-6 mm Hg reduction in systolic blood pressure, which presumably leads to reduced cardiovascular disease morbidity and mortality. However, in observational cohort studies that used not blood pressure but actual health conditions as outcomes, the presumed relation between sodium intakes <2500 mg/d was not observed. Thus, the blood pressure effect of sodium restriction can no longer be accepted as a surrogate for health outcomes associated with sodium intake. Evidence that reducing sodium intakes to <2500 mg/d will improve health is needed to justify continuing efforts to modify diet.
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Affiliation(s)
- Michael H Alderman
- Departments of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Graudal N, Jürgens G, Baslund B, Alderman MH. Compared with usual sodium intake, low- and excessive-sodium diets are associated with increased mortality: a meta-analysis. Am J Hypertens 2014; 27:1129-37. [PMID: 24651634 DOI: 10.1093/ajh/hpu028] [Citation(s) in RCA: 275] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The effect of sodium intake on population health remains controversial. The objective was to investigate the incidence of all-cause mortality (ACM) and cardiovascular disease events (CVDEs) in populations exposed to dietary intakes of low sodium (<115 mmol), usual sodium (low usual sodium: 115-165 mmol; high usual sodium: 166-215 mmol), and high sodium (>215 mmol). METHODS The relationship between individual measures of dietary sodium intake vs. outcome in cohort studies and randomized controlled trials (RCTs) measured as hazard ratios (HRs) were integrated in meta-analyses. RESULTS No RCTs in healthy population samples were identified. Data from 23 cohort studies and 2 follow-up studies of RCTs (n = 274,683) showed that the risks of ACM and CVDEs were decreased in usual sodium vs. low sodium intake (ACM: HR = 0.91, 95% confidence interval (CI) = 0.82-0.99; CVDEs: HR = 0.90, 95% CI = 0.82-0.99) and increased in high sodium vs. usual sodium intake (ACM: HR = 1.16, 95% CI = 1.03-1.30; CVDEs: HR = 1.12, 95% CI = 1.02-1.24). In population representative samples adjusted for multiple confounders, the HR for ACM was consistently decreased in usual sodium vs. low sodium intake (HR = 0.86; 95% CI = 0.81-0.92), but not increased in high sodium vs. usual sodium intake (HR = 1.04; 95% CI = 0.91-1.18). Within the usual sodium intake range, the number of events was stable (high usual sodium vs. low usual sodium: HR = 0.98; 95% CI = 0.92-1.03). CONCLUSIONS Both low sodium intakes and high sodium intakes are associated with increased mortality, consistent with a U-shaped association between sodium intake and health outcomes.
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Affiliation(s)
- Niels Graudal
- Department of Rheumatology IR4242, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Gesche Jürgens
- Department of Clinical Pharmacology, Bispebjerg University Hospital, Copenhagen Denmark
| | - Bo Baslund
- Department of Rheumatology IR4242, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Hsieh FI, Chiou HY. Stroke: morbidity, risk factors, and care in taiwan. J Stroke 2014; 16:59-64. [PMID: 24949310 PMCID: PMC4060269 DOI: 10.5853/jos.2014.16.2.59] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 11/18/2022] Open
Abstract
Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke, it was successful to increased annual smoke cessation rate through the 2009 Tobacco Hazards Prevention Act and decreased obesity rate through a nationwide weight-loss program conducted by Health Promotion Administration from 2011 to 2013 in Taiwan.
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Affiliation(s)
- Fang-I Hsieh
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Hung-Yi Chiou
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan
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Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies. Public Health Nutr 2014; 18:695-704. [PMID: 24848764 DOI: 10.1017/s1368980014000949] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality. DESIGN We performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. Settings MEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study. Subject Eleven prospective studies with 229 785 participants and average follow-up period of 13.37 years (range 5.5-19 years). RESULTS Higher Na intake was significantly associated with higher CVD mortality (relative risk=1.12; 95 % CI 1.06, 1.19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1.08; 95 % CI 1.01, 1.15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0.016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality. CONCLUSIONS Higher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.
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Yoshimatsu J, Ikeda T, Katsuragi S, Minematsu K, Toyoda K, Nagatsuka K, Naritomi H, Miyamoto S, Iihara K, Yamamoto H, Ohno Y. Factors contributing to mortality and morbidity in pregnancy-associated intracerebral hemorrhage in Japan. J Obstet Gynaecol Res 2014; 40:1267-73. [DOI: 10.1111/jog.12336] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jun Yoshimatsu
- Department of Perinatology and Gynecology; National Cerebral and Cardiovascular Center; Osaka Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology; Mie University; Osaka Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynecology; Sakakibara Heart Institute; Tokyo Japan
| | - Kazuo Minematsu
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine; National Cerebral and Cardiovascular Center; Suita Japan
| | - Kazuyuki Nagatsuka
- Department of Neurology; National Cerebral and Cardiovascular Center; Suita Japan
| | - Hiroaki Naritomi
- Department of Neurology; National Cerebral and Cardiovascular Center; Suita Japan
| | - Susumu Miyamoto
- Department of Neurosurgery; National Cerebral and Cardiovascular Center; Suita Japan
| | - Koji Iihara
- Department of Neurosurgery; National Cerebral and Cardiovascular Center; Suita Japan
| | - Haruko Yamamoto
- Advanced Medical Technology Development; National Cerebral and Cardiovascular Center; Suita Japan
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Estol CJ, Bath PMW, Gorelick PB, Cotton D, Martin RH. Differences in ischemic and hemorrhagic recurrence rates among race-ethnic groups in the PRoFESS secondary stroke prevention trial. Int J Stroke 2014; 9 Suppl A100:43-7. [PMID: 24636673 DOI: 10.1111/ijs.12269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 02/02/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Epidemiological studies show that vascular risk factors are the same across the world but their effect vary between different race-ethnic groups. However, few studies have evaluated differences in recurrent stroke rates in various race-ethnicities. In >20 000 patients spanning 35 countries encompassing most race-ethnicities, we evaluated the incidence of ischemic and hemorrhagic strokes and myocardial infarction in patients within the context of the largest secondary stroke prevention trial (Prevention Regimen for Effectively Avoiding Secondary Strokes) to identify any significant differences. METHODS There were 20 332 patients with a recent ischemic stroke randomized in a factorial design to receive the antiplatelet agent clopidogrel vs. aspirin plus extended-release dipyridamole, and 80 mg of the anthypertensive telmisartan vs. placebo. The primary outcome for the trial was the time to any recurrent stroke. Statistical analysis was used to detect race-ethnic differences in recurrent vascular events. RESULTS Mean patient age was 66 (±8·6) years and 36% were women. The study included 58% European/Caucasian, 33% Asians, 5% Latin/Hispanic, and 4% Black African. There were 74% of patients that were hypertensive, and average systolic and diastolic blood pressure was 144·1/83·8 mmHg. There was at least one significant difference in the overall test of all race-ethnic groups in myocardial infarction and symptomatic intracerebral hemorrhage occurrence. In the Kaplan-Meier hemorrhage and stroke-free survival curves, Asians showed a significantly higher recurrence of ischemic stroke risk in the 135-150 mmHg and greater than 150 mm Hg blood pressure groups, and a greater risk of hemorrhage recurrence in the greater than 150 mmHg blood pressure group. CONCLUSIONS We found a significant difference in myocardial infarction and symptomatic intracerebral hemorrhage recurrence among different race-ethnic groups. The risk of recurrent ischemic and hemorrhagic stroke was greater in Asians with high blood pressure.
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Zhang R, Wang X, Tang Z, Liu J, Yang S, Zhang Y, Wei Y, Luo W, Wang J, Li J, Chen B, Zhang K. Apolipoprotein E gene polymorphism and the risk of intracerebral hemorrhage: a meta-analysis of epidemiologic studies. Lipids Health Dis 2014; 13:47. [PMID: 24621278 PMCID: PMC3984699 DOI: 10.1186/1476-511x-13-47] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 09/20/2013] [Indexed: 11/18/2022] Open
Abstract
Background Studies investigating the association between the apolipoprotein E (APOE) gene polymorphism and the risk of intracerebral hemorrhage (ICH) have reported conflicting results. We here performed a meta-analysis based on the evidence currently available from the literature to make a more precise estimation of this relationship. Methods Published literature from the National Library of Medline and Embase databases were retrieved. Odds ratio (OR) and 95% confidence interval (CI) were calculated in fixed- or random-effects models when appropriate. Subgroup analyses were performed by race. Results This meta-analysis included 11 case–control studies, which included 1,238 ICH cases and 3,575 controls. The combined results based on all studies showed that ICH cases had a significantly higher frequency of APOE ϵ4 allele (OR= 1.42, 95% CI= 1.21,1.67, P<0.001). In the subgroup analysis by race, we also found that ICH cases had a significantly higher frequency of APOE ϵ4 allele in Asians (OR= 1.52, 95% CI= 1.20,1.93, P<0.001) and in Caucasians (OR= 1.34, 95% CI= 1.07,1.66, P=0.009). There was no significant relationship between APOE ϵ2 allele and the risk of ICH. Conclusion Our meta-analysis suggested that APOE ϵ4 allele was associated with a higher risk of ICH.
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Affiliation(s)
| | - Xiaofeng Wang
- Department of Neurosurgery, Third Hospital of Chinese PLA, 45 Dongfeng Road, Jin Tai District, Baoji 721004, Shanxi Province, China.
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Hung PH, Huang YT, Hsiao CY, Sung PS, Guo HR, Tsai KJ. Young stroke patients are at high risk for subsequent end-stage renal disease: a population-based observational study. Nephrol Dial Transplant 2014; 29:873-8. [DOI: 10.1093/ndt/gft534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chen YC, Sun CA, Yang T, Chu CH, Bai CH, You SL, Hwang LC, Chen CH, Wei CY, Chou YC. Impact of metabolic syndrome components on incident stroke subtypes: a Chinese cohort study. J Hum Hypertens 2014; 28:689-93. [PMID: 24430706 DOI: 10.1038/jhh.2013.152] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 12/09/2013] [Accepted: 12/11/2013] [Indexed: 11/09/2022]
Abstract
Limited evidence is available on the risk differences in the development of stroke subtypes in relation to particular clustering patterns of the metabolic syndrome (MetS) components. A follow-up study of a Chinese cohort involving 10,292 individuals was performed to assess the roles of cluster patterns of the MetS components in the prediction of incident stroke subtypes. During follow-up, there were 161 incident cases of ischemic strokes and 41 incident cases of hemorrhagic strokes. Among MetS components, only the hypertensive trait was associated with significantly elevated risks of both ischemic and hemorrhagic strokes. Furthermore, MetS with hypertension as components was associated with increased risk of ischemic and hemorrhagic strokes (adjusted hazards ratio (95% confidence interval) was 2.96 (1.94-4.50) and 2.93 (1.25-6.90), respectively) as compared with those who had neither hypertension nor MetS. Notably, as the number of the MetS components increased, the risk of ischemic stroke significantly and dose-dependently increased. This implies a cumulative effect of MetS components in elevating the risk of ischemic stroke. These findings suggest that MetS comprises heterogenous clusters with respect to the risk of developing the subtype of stroke.
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Affiliation(s)
- Y-C Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - C-A Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, Republic of China
| | - T Yang
- Department of Health Business Administration, Meiho University, Pingtung, Taiwan, Republic of China
| | - C-H Chu
- Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - C-H Bai
- School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei City, Taiwan, Republic of China
| | - S-L You
- 1] Genomics Research Center, Academia Sinica, Taipei City, Taiwan, Republic of China [2] School of Public Health, National Defense Medical Center, Taipei City, Taiwan, Republic of China
| | - L-C Hwang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan, Republic of China
| | - C-H Chen
- Digestive Disease Center, Changhua Show-Chwan Memorial Hospital, Changhua County, Taiwan, Republic of China
| | - C-Y Wei
- Department of Neurology, Chang Bing Show-Chwan Memorial Hospital, Changhua County, Taiwan, Republic of China
| | - Y-C Chou
- 1] Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan, Republic of China [2] School of Public Health, National Defense Medical Center, Taipei City, Taiwan, Republic of China
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Chen HF, Li CY, Lee SP, Kwok YT, Chu YT. Improving the One-Year Mortality of Stroke Patients: An 18-Year Observation in a Teaching Hospital. TOHOKU J EXP MED 2014; 232:47-54. [DOI: 10.1620/tjem.232.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hua-Fen Chen
- Department of Endocrinology, Far Eastern Memorial Hospital
- School of Medicine, Fujen Catholic University
| | - Chung-Yi Li
- Department of Public Health, College of Medicine, National Cheng Kung University
- Department of Public Health, China Medical University
| | - Siu-Pak Lee
- Department of Neurology, Far Eastern Memorial Hospital
| | - Yam-Ting Kwok
- Department of Neurology, Far Eastern Memorial Hospital
| | - Yiu-Tong Chu
- Department of Neurology, Far Eastern Memorial Hospital
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Chen PS, Cheng CL, Kao Yang YH, Yeh PS, Li YH. Impact of early statin therapy in patients with ischemic stroke or transient ischemic attack. Acta Neurol Scand 2014; 129:41-8. [PMID: 23758549 DOI: 10.1111/ane.12143] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Statin therapy has demonstrated benefits in ischemic stroke patients. However, little is known about whether the timing of statin initiation affects clinical outcomes. The possible association of statin use and cerebral hemorrhage is also a concern for early statin therapy after stroke. The objective of this study was to evaluate the efficacy and safety of the initiation timing of statins in acute ischemic stroke. METHODS A cohort study was performed using 5-year National Health Insurance Research Database in Taiwan. Patients without prior statin therapy admitted for their new ischemic stroke or transient ischemic attack (TIA) were enrolled. Patients were recognized as inhospital use group (2019 patients, statin initiation during hospitalization), intermediate use group (2266 patients, statin initiation within 1 year after discharge) or late use group (2958 patients, statin initiation 1 year later after discharge). The study endpoint was the composite outcome of ischemic stroke, TIA, hemorrhagic stroke, or acute coronary event. RESULTS As compared with inhospital use, patients with late use had a 49% increased risk (adjusted HR: 1.49, 95% CI: 1.26-1.76) of composite endpoint. In contrast, patients with intermediate use had similar risk of endpoint as those with inhospital use. The risk of cerebral hemorrhage was similar in patients receiving inhospital, intermediate, or late statin treatment. CONCLUSIONS In acute ischemic stroke, patients receiving late statin treatment carried a poorer clinical outcome than those with earlier statin initiation. Inhospital statin use after an acute ischemic stroke did not increase the risk of cerebral hemorrhage.
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Affiliation(s)
- P.-S. Chen
- Department of Internal Medicine; National Cheng Kung University Hospital and College of Medicine; Tainan City Taiwan
| | - C.-L. Cheng
- Institute of Clinical Pharmacy and Institute of Biopharmaceutical Sciences; College of Medicine; National Cheng Kung University; Tainan City Taiwan
| | - Y.-H. Kao Yang
- Institute of Clinical Pharmacy and Institute of Biopharmaceutical Sciences; College of Medicine; National Cheng Kung University; Tainan City Taiwan
| | - P.-S. Yeh
- Department of Neurology; Chi-Mei Medical Center; Tainan City Taiwan
| | - Y.-H. Li
- Department of Internal Medicine; National Cheng Kung University Hospital and College of Medicine; Tainan City Taiwan
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Wu X, Zhu B, Fu L, Wang H, Zhou B, Zou S, Shi J. Prevalence, incidence, and mortality of stroke in the chinese island populations: a systematic review. PLoS One 2013; 8:e78629. [PMID: 24250804 PMCID: PMC3826735 DOI: 10.1371/journal.pone.0078629] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/13/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In China, there are 2.5 million new stroke cases each year and 7.5 million stroke survivors. However, stroke incidence in some island populations is obviously lower compared with inland regions, perhaps due to differences in diet and lifestyle. As the lifestyle in China has changed significantly, along with dramatic transformations in social, economic and environmental conditions, such changes have also been seen in island regions. Thus, we analyzed stroke in the Chinese island regions over the past 30 years. METHODS We conducted a systematic review to identify reliable and comparable epidemiologic evidence about stroke in the Chinese island regions between 1980 and 2013. Two authors independently assessed the eligibility and the quality of the articles and disagreement was resolved by discussion. Owing to the great heterogeneity among individual study estimates, a random-effects or fixed-effects model was used to incorporate the heterogeneity among records into a pooled estimate for age-standardized rates. Age-standardized rates were calculated by the direct method with the 2000 world population if included records provided the necessary information. RESULTS During the past three decades, the overall pooled age-standardized prevalence of stroke is 6.17 per 1000 (95% CI 4.56-7.78), an increase from 5.54 per 1000 (95% CI 3.88-7.20) prior to 2000 to 8.34 per 1000 (95% CI 5.98-10.69) after 2000. However, this difference was not found to be statistically significant. The overall pooled age-standardized incidence of stroke is 120.42 per 100,000 person years (95% CI 26.17-214.67). Between 1982 and 2008, the incidence of stroke increased and mortality declined over time. CONCLUSIONS Effective intervention and specific policy recommendations on stroke prevention should be required, and formulated in a timely fashion to effectively curb the increased trend of stroke in Chinese island regions.
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Affiliation(s)
- Xiaomei Wu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Bo Zhu
- Liaoning Academy of Safety Sciences, Shenyang, China
- Department of Environmental and Occupational Health, School of Public Health, China Medical University, Taichung, Taiwan
| | - Lingyu Fu
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Hailong Wang
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Bo Zhou
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
| | - Safeng Zou
- Department of Neurology, Dalian Municipal Central Hospital, Dalian, China
| | - Jingpu Shi
- Department of Clinical Epidemiology and Center of Evidence Based Medicine, Institute of Cardiovascular, The First Hospital of China Medical University, Shenyang, China
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